Provider Demographics
NPI:1174902563
Name:HERZOG, TRACY LAUREN
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LAUREN
Last Name:HERZOG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LAUREN
Other - Last Name:ALFTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7752 MORNINGSIDE LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5836
Mailing Address - Country:US
Mailing Address - Phone:909-936-7700
Mailing Address - Fax:
Practice Address - Street 1:7752 MORNINGSIDE LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5836
Practice Address - Country:US
Practice Address - Phone:909-936-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist